Palliative Sedation An ICU Perspective. William Anderson; B.Sc. MD FRCP(C) Department of Critical Care Thunder Bay Regional HSC
|
|
- Merilyn Berenice Price
- 5 years ago
- Views:
Transcription
1 Palliative Sedation An ICU Perspective William Anderson; B.Sc. MD FRCP(C) Department of Critical Care Thunder Bay Regional HSC
2 Conflict Disclosure Information: Presenter: Dr. Will Anderson I have no financial or personal relationships to disclose
3 To cure sometimes, to comfort always, to hurt the least, to harm never Ajai Singh, Shakuntala Singh, Mens Sana Monographs; 2006:4:1:8-9
4 ICU Perspectives Common scenarios in critically ill patients: Failure of aggressive therapies Realization of futility Avoidance of undesirable outcome Natural progression of end-stage disease
5 ICU Perspectives Common scenarios in critically ill patients: Failure of aggressive therapies Eg: Septic shock with MSOF Realization of futility Eg: Massive intra-cerebral hemorrhage Avoidance of undesirable outcome Eg: Persistent Vegetative State Natural progression of end-stage disease Eg: End-Stage COPD or CHF, Malignancies
6 Goals Optimal control of suffering at the end of life. Pain Dyspnea Anxiety Psychological or Spiritual Distress
7 Methods Optimal control of suffering at the end of life. Pain Narcotics: infusions and boluses prn Anxiety Benzodiazepines, sometimes antipsychotics Dyspnea Morphine, other narcotics, ventilatory support Psychologic and Spiritual distress Family, Clergy, Nurse, Social Work, PC Nurse, Physician and control of above symptoms.
8 Case Scenario #1 71 yo woman with severe kyphoscoliosis Presents with Pneumonia, Septic Shock, Acute Renal Failure, Shock Liver. Not feasible to intubate or do CPR b/c of body habitus Requiring aggressive hemodynamic support and non-invasive ventilation Increasing vasopressor requirements Progressive renal failure Worsening ventilatory status... Now what?
9 Case Scenario #2 63 yo man with severe HTN C/O worst headache of my life then collapses at home Brought to ER by ambulance, intubated for airway protection CT-Head shows Massive ICH Patient s family want to talk... Now what?
10 Case Scenario #3 55 yo male found unresponsive at home Wife heard bump, went to investigate, calls EMS, starts CPR Presenting rhythm VF - total 45 mins CPR before ROSC, intubated without sedation in ER Admitted to ICU requiring vasopressor support Comatose and showing myoclonus
11 Case Scenario #3 Hypothermic therapy for 24 hours with deep sedation and chemical paralysis Antibiotics for aspiration pneumonia Now 72 hours post-arrest, deeply comatose, ongoing myoclonus, no sedation for 48 hours Now off vasopressor therapy, respiratory function improving What now?
12 Case Scenario #4 95 yo Catholic Priest Longstanding history of heart disease, recurrent CHF Admitted with decompensated Heart Failure. DNR, DNI Has been on non-invasive ventilation for 8 days along with aggressive medical Rx Not improving, getting more and more tired... What should we do now?
13 Case Scenario #5 86 yo man with Hx of Myelodysplastic Syndrome, on steroids for ~1 year Lives with wife at home, functional Controlled HTN, T2DM Remote CVA, Aorto-BiFem bypass Progressive pancytopenia due to BM infiltration Presents with Severe Anemia (Hgb 64) and chest pain
14 Case Scenario #5 Patient is DNR, DNI, doesn t want aggressive therapy Admitted to Palliative Care Unit Transfused 3 units blood Progressive severe dyspnea, unresponsive to SQ Morphine and Versed Patient is very uncomfortable, suffering quite severely Family wants better symptom control; asks for IV narcotics and palliative non-invasive ventilation What do you think?
15 Case Scenario #6 63 yo woman with end-stage COPD Increasing frequency of hospital admissions for AE-COPD despite maximal medical Rx Understands that she is dying of her disease Very afraid of dying, doesn t want to suffocate to death Has had non-invasive ventilation many times, finds that it helps
16 Case Scenario #6 Wants to die in hospice with skilled palliative care and optimal symptom control Wants the option of palliative ventilation at the end of her life Should this support modality be provided to patients who need it? What do you think?
17 A physician should essentially be human. He deals with human beings with their burden of worries, sorrows and sufferings. Scientific training helps him to provide relief to the patient's physical ailments, but a humane, compassionate approach touches and consoles the patient's aching mind and soul. No physician or medicine can prevent death, but a caring physician can make the transition from life to death less painful. Every physician should know his limitations, keeping in mind the great panorama of life and the universal power that shapes it all. Thus, a good physician is also a good philosopher. V Balakrishnan; The Making of a Physician Mens Sana Monographs; 2009: 7: 1:
18 Thank you!
Easing the transition from curative care to palliative care
Easing the transition from curative care to palliative care Manon Coulombe, RN, MSc(A), CHPCN(C) Pivot nurse in palliative care mcoulombe2.hmr@ssss.gouv.qc.ca Presentation My clinical practice Characteristics
More informationEnd of Life Care Communication and Advance Illness Care Planning. Gideon Sughrue MD May 18, 2013
End of Life Care Communication and Advance Illness Care Planning Gideon Sughrue MD May 18, 2013 Objectives End of life Care Communication Describe Palliative Care Place in therapy What is hospice? What
More informationEnd of Life Care in IJN Our journey. Dato Dr. David Chew Soon Ping Consultant Cardiologist National Heart Institute Malaysia
End of Life Care in IJN Our journey Dato Dr. David Chew Soon Ping Consultant Cardiologist National Heart Institute Malaysia End of Life Dying is final part of everyone journey in life Deaths used to occur
More informationObjectives. End-of-Life Exercise. Palliative Care Can Help Patients and Decrease 30-Day Hospital Readmissions.
Palliative Care Can Help Patients and Decrease 30-Day Hospital Readmissions. Objectives Describe how palliative care meets the needs of the patient and family. Discuss how out-patient palliative care can
More informationEND OF LIFE ISSUES. 41 st Semi-Annual Family Practice Review Course Lewis Katz School of Medicine at Temple University
END OF LIFE ISSUES 41 st Semi-Annual Family Practice Review Course Lewis Katz School of Medicine at Temple University Stanley J. Savinese DO FAAHPM HMDC Medical Director VNA Hospice of Philadelphia Co-Director
More informationVentilation/End of Life Neuromuscular Disorders. Dr Emma Husbands Consultant Palliative Medicine
Ventilation/End of Life Neuromuscular Disorders Dr Emma Husbands Consultant Palliative Medicine Emma.Husbands@glos.nhs.uk Contents Cases NIV and palliation and ethical bits APM guidelines Important bits
More informationEmergency Palliative Care
Emergency Palliative Care Dr Jenny Hynson Consultant Paediatrician Victorian Paediatric Palliative Care Program (VPPCP) Royal Children s Hospital, Melbourne Points of discussion What is palliative care?
More informationPalliative Care In PICU
Palliative Care In PICU Professor Lucy Lum University Malaya Annual Scientific Meeting on Intensive Care 15 August 2015 2 Defining Palliative Care: Mistaken perception: For patients whom curative care
More informationPost-Resuscitation Care. Prof. Wilhelm Behringer Center of Emergency Medicine University of Jena
Post-Resuscitation Care Prof. Wilhelm Behringer Center of Emergency Medicine University of Jena Conflict of interest Emcools Shareholder and founder, honoraria Zoll: honoraria Bard: honoraria, nephew works
More informationWhere Emergency Medicine Meets Critical Care: Next Level Resuscitation
Where Emergency Medicine Meets Critical Care: Next Level Resuscitation Rob Green, BSc, MD, DABEM, FRCPC, FRCP(Edin) Professor, Dalhousie University Departments of Emergency Medicine,Critical Care Medicine
More informationNIV - BI-LEVEL POSITIVE AIRWAY PRESSURE (BIPAP)
Introduction NIV - BI-LEVEL POSITIVE AIRWAY PRESSURE (BIPAP) Noninvasive ventilation (NIV) is a method of delivering oxygen by positive pressure mask that allows for the prevention or postponement of invasive
More informationDyspnea: The top things you need to you know! Dr. Megan Sellick & Dr. Lawrence Lee Edmonton Zone Palliative Care Program
: The top things you need to you know! Dr. Megan Sellick & Dr. Lawrence Lee Edmonton Zone Palliative Care Program Faculty / Presenter Disclosure Faculty: Dr. Lawrence Lee Relationships with commercial
More informationAVOIDING THE CRASH: OPTIMIZE YOUR PRE, PERI, AND POST AIRWAY MANAGEMENT AVOIDING THE CRASH 1: DON T INTUBATE, OPTIMIZE PRE-AIRWAY MANAGEMENT
AVOIDING THE CRASH: OPTIMIZE YOUR PRE, PERI, AND POST AIRWAY MANAGEMENT Robert J. Vissers MD Chief, Emergency Medicine, Quality Chair, Legacy Emanuel Medical Center Adjunct Associate Professor, OHSU Portland,
More informationDyspnea: Should we use BIPAP?
Dyspnea: Should we use BIPAP? Thomas R. Gildea MD, MS FCCP Head Section of Bronchoscopy Respiratory Institute Transplant Center Disclosure SuperDimension Inc. PI for single center study Others: Aeris,
More informationPalliative Emergencies. Ken Stakiw
Palliative Emergencies Ken Stakiw Disclosure None to disclose for this lecture Have received honoraria from a number of agencies and companies previously Intend to discuss some off label use of medications
More informationOxygen and ABG. Dr Will Dooley
Oxygen and ABG G Dr Will Dooley Oxygen and ABGs Simply in 10 cases Recap of: ABG interpretation Oxygen management Some common concerns A-a gradient Base Excess Anion Gap COPD patients CPAP/BiPAP First
More informationThe Role of Palliative Care in Advanced Lung Disease
The Role of Palliative Care in Advanced Lung Disease Timothy B. Short, MD, FAAFP, FAAHPM Associate Professor, Palliative Medicine University of Virginia Learning Objectives Describe palliative care s approach
More informationCOPD AND PALLIATIVE CARE JEAN WATERS FNP-BC SENTARA RMH PALLIATIVE CARE JANUARY 13, 2018
COPD AND PALLIATIVE CARE JEAN WATERS FNP-BC SENTARA RMH PALLIATIVE CARE JANUARY 13, 2018 THOUGHTS TO CONSIDER What is Palliative Care? COPD and impact on Quality of Life. Prognosis and impact of co-morbidities
More informationCommon Confounding Consults In Pulmonary & Critical Care
Common Confounding Consults In Pulmonary & Critical Care Lekshmi Santhosh, M.D. Assistant Professor, Pulm/Critical Care & Hosp Med Management of the Hospitalized Patient 10.20.2018 Disclosures None. 1
More informationResponding to Requests for Hastened Death in an Environment Where the Practice is Legally Prohibited
Responding to Requests for Hastened Death in an Environment Where the Practice is Legally Prohibited Timothy E. Quill MD, MACP, FAAHPM Palliative Care Division, Department of Medicine Rochester, New York
More informationPalliative Care in the ED:
Palliative Care in the ED: Don t Just Do Something Stand There Eric Isaacs, MD, FACEP Attending Physician, San Francisco General Hospital and Trauma Center Professor of Emergency Medicine, University of
More informationPalliative Care under a Value Based Reimbursement Model. Janet Bull MD, MBA, FAAHPM CMO Four Seasons
Palliative Care under a Value Based Reimbursement Model Janet Bull MD, MBA, FAAHPM CMO Four Seasons Objectives o Describe palliative care o Discuss benefits of palliative care o Understand differences
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Acute coronary syndrome (ACS), burden of condition, 83 diagnosis of, 82 83 evaluation of, 83, 87 major complications of, 86 risk for,
More informationIdentify essential primary palliative care (PPC) communication skills that every provider needs AND clinical triggers for PPC conversations
Identify essential primary palliative care (PPC) communication skills that every provider needs AND clinical triggers for PPC conversations Esmé Finlay, MD Division of Palliative Medicine University of
More informationPalliative Care In Respirology: Who s job is it, anyway?! Everyones!
Palliative Care In Respirology: Who s job is it, anyway?! Everyones! Dr. Shalini Nayar MD Respiratory Medicine Palliative Medicine Clinical Assistant Professor, Dept of Medicine, UBC Canadian Cancer Society
More informationMajor Points. The ED-ICU Interface. Chain of Survival. It usually starts here
Major Points The ED-ICU Interface Robert M. Rodriguez, MD FAAEM Most ICU patients start in ED Chain of critical care starting in field and ED Collaborate, develop protocols (define roles), communicate
More informationPalliative Care: What is it?
Palliative Care: What is it? CSIM Annual Meeting 2014 Calgary Dr. Amanda Brisebois MSc MD FRCPC General Internal Medicine and Palliative Care What has surprised me is how little palliative care has to
More informationTherapeutic hypothermia
INDUCED HYPOTHERMIA Dr. Attilla Kiss M.D. Acting Medical Director Emergency Services EMS Medical Director St. John Medical Center OBJECTIVES Define and explain Induced Hypothermia Discuss both pre-hospital
More informationStayin Alive: Pediatric Advanced Life Support (PALS) Updated Guidelines
Stayin Alive: Pediatric Advanced Life Support (PALS) Updated Guidelines Margaret Oates, PharmD, BCPPS Pediatric Critical Care Specialist GSHP Summer Meeting July 16, 2016 Disclosures I have nothing to
More information5/3/2012 PRESENTATION GOALS RESPIRATORY THERAPISTS ROLE IN END OF LIFE CARE FOR THE PULMONARY PATIENT
RESPIRATORY THERAPISTS ROLE IN END OF LIFE CARE FOR THE PULMONARY PATIENT Presented by Carrie Black Bourassa, LRT, RRT PRESENTATION GOALS Define palliative care Define hospice care Discuss pulmonary hospice
More informationManagement of Dyspnea and Cough in Lung Cancer
Management of Dyspnea and Cough in Lung Cancer Dr. Chris Ogaranko Lung Cancer Educational Event November 2013 Presenter Disclosure Faculty: Dr. Chris Ogaranko Relationships with commercial interests: Grants/Research
More informationI Wanna Be Sedated: Palliative Sedation March 30, 2017 Emily L. Riegel, MD
I Wanna Be Sedated: Palliative Sedation March 30, 2017 Emily L. Riegel, MD 1 NATION'S LARGEST HOSPICE DID NOT PROVIDE A YOUNG MOTHER WITH A 'PEACEFUL DEATH NOV. 19, 2010 The family of a young Los Gatos
More informationPost-Cardiac Arrest Syndrome. MICU Lecture Series
Post-Cardiac Arrest Syndrome MICU Lecture Series Case 58 y/o female collapses at home, family attempts CPR, EMS arrives and notes VF, defibrillation x 3 with return of spontaneous circulation, brought
More informationBreathlessness in advanced disease. February 2017
Breathlessness in advanced disease February 2017 Breathlessness Managing breathlessness in primary care Chronic breathlessness Acute exacerbation of breathlessness Breathlessness at end of life Breathlessness
More informationRefractory Seizures. Dr James Edwards EMCORE May 30th 2014
Refractory Seizures Dr James Edwards EMCORE May 30th 2014 Refractory Seizures Seizures are a common presentation to the ED and some patients will have multiple seizures or have a reduced level of consciousness
More informationIN HOSPITAL CARDIAC ARREST AND SEPSIS
IN HOSPITAL CARDIAC ARREST AND SEPSIS MARGARET DISSELKAMP, MD OVERVIEW Background Epidemiology of in hospital cardiac arrest (IHCA) Use a case scenario to introduce new guidelines Review surviving sepsis
More informationPalliative Care and Hospice. Silver Linings: Reflecting on Our Past & Transitioning into our Future
Palliative Care and Hospice Silver Linings: Reflecting on Our Past & Transitioning into our Future Objectives: 1. What is Palliative Care? What is Hospice? What is the difference? 2. What are the trending
More informationACUTE HEART FAILURE. Julie Gorchynski MD, MSc, FACEP, FAAEM. Department of Emergency Medicine Emergency Residency Program UTHSC, San Antonio TCEP 2014
ACUTE HEART FAILURE Julie Gorchynski MD, MSc, FACEP, FAAEM Department of Emergency Medicine Emergency Residency Program UTHSC, San Antonio TCEP 2014 No disclosures Objectives Overview Cases Current Therapy
More informationHOSPICE My lecture outline
Objectives: o Describe a brief history of the development of hospice care o Describe the hospice philosophy of care o Describe the referral process o Describe hospice services o Describe reimbursement
More informationEnsuring Communication of Healthcare Wishes: Bridging the Gap between Medical Directives and End-of-Life Care. A Doctor s Perspective
Ensuring Communication of Healthcare Wishes: Bridging the Gap between Medical Directives and End-of-Life Care A Doctor s Perspective Tammie E. Quest, MD Director, Emory Palliative Care Center Associate
More informationPulmonary Rehabilitation and Palliative Care. Sindhu Mukku, MD Pulmonary/Critical Care Fellow, PGY-5 February 26, 2013
Pulmonary Rehabilitation and Palliative Care Sindhu Mukku, MD Pulmonary/Critical Care Fellow, PGY-5 February 26, 2013 Outline 1. Define palliative care and end of life care Palliative Care in COPD 2. Patient
More informationSymptom Management and Palliative Care for Lung Cancer
Symptom Management and Palliative Care for Lung Cancer DorAnne Donesky, PhD, ANP-BC, ACHPN Professor of Clinical Nursing Dept of Physiological Nursing Disclosures The presenter has no relevant financial
More informationWhen to think about palliation
When to think about palliation Hannah Wunsch, MD MSc Department of Critical Care Medicine, Sunnybrook Health Sciences Centre Associate Professor of Anesthesiology, University of Toronto Visiting Assistant
More informationCase Scenarios. Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC. Consultant, Critical Care Medicine Medanta, The Medicity
Case Scenarios Dr Shrikanth Srinivasan MD,DNB,FNB,EDIC Consultant, Critical Care Medicine Medanta, The Medicity Case 1 A 36 year male with cirrhosis and active GI bleeding is intubated to protect his airway,
More informationVents, LVADs, and Hospice Oh My!
Vents, LVADs, and Hospice Oh My! Colleen Gilmore RN, MSN, ANP-BC Patrick White MD, HMDC, FACP, FAAHPM 1 Disclosure: White, Patrick, M.D. Patrick White M.D. has financial interests to disclose. Potential
More informationThe Role of Palliative Care in the Management of Advanced Heart Failure
Disclosure The Role of Palliative Care in the Management of Advanced Heart Failure I have no conflict of interest to disclose. Darrell Craig MD Medical Director, Palliative Care Services St. Joseph Mercy
More information12/6/2016. Objective PALLIATIVE CARE IN THE NURSING HOME. Medical Care in the US. Palliative Care
Objective PALLIATIVE CARE IN THE NURSING HOME Deborah Morris, M.D., M.H.S. Assistant Professor of Medicine The Glennan Center for Geriatrics and Gerontology Eastern Virginia Medical School Describe program
More informationObjectives 2/11/2016 HOSPICE 101
HOSPICE 101 Overview Hospice History and Statistics What is Hospice? Who qualifies for services? Levels of Service The Admission Process Why Not to Wait Objectives Understand how to determine hospice eligibility
More informationDisclosure of Financial Relationships
Implementing the Advance Care Plan & POLST Kenneth Brummel-Smith, M.D. Charlotte Edwards Maguire Professor and Chair, Department of Geriatrics Florida State University College of Medicine Disclosure of
More informationCRRT Fundamentals Pre-Test. AKI & CRRT 2017 Practice Based Learning in CRRT
CRRT Fundamentals Pre-Test AKI & CRRT 2017 Practice Based Learning in CRRT Question 1 A 72-year-old man with HTN presents to the ED with slurred speech, headache and weakness after falling at home. He
More informationCPR What Works, What Doesn t
Resuscitation 2017 ECMO and ECLS April 1, 2017 Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN Circulation 2013;128:417-35
More information1 per person. Prognostication. Current Death Rate? 8/10/2017. Dying Healed: A Shared Quest for Wholeness
Dying Healed: A Shared Quest for Wholeness Deborah Grassman ARNP www.opuspeace.org www.soulinjury.org Prognostication Difficult topic today one that is often avoided and undervalued. Review some research,
More informationSARASOTA MEMORIAL HOSPITAL NURSING DEPARTMENT POLICY
PS1070 SARASOTA MEMORIAL HOSPITAL NURSING DEPARTMENT POLICY TITLE: ADMISSION/DISCHARGE CRITERIA: CARDIOVASCULAR INTENSIVE Job Title of Reviewer: Director, CVICU EFFECTIVE DATE: REVIEWED/REVISED DATE: POLICY
More informationPitfalls in Shortness of Breath
Pitfalls in Shortness of Breath Stuart Swadron, MD FRCPC FACEP Vice-Chair of Education and Program Director Department of Emergency Medicine Los Angeles County-University of Southern California Medical
More informationCSIM annual meeting Acute respiratory failure. Dr. John Ronald, FRCPC Int Med, Resp, CCM. October 10, 2018
CSIM annual meeting - 2018 Acute respiratory failure Dr. John Ronald, FRCPC Int Med, Resp, CCM. October 10, 2018 NRGH affiliated with UBC medicine Disclosures None relevant to this presentation. Also no
More information4. Which survey program does your facility use to get your program designated by the state?
TRAUMA SURVEY Please complete one survey for each TCD designation you have in your facility. There would be a maximum of three surveys completed if your facility was designated as a trauma, stroke and
More informationSo let s go through each disease then and understand some of the established prognostic factors starting with COPD.
Okay, I am Dr. David Hui from the Department of Palliative Care from The University of Texas MD Anderson Cancer Center and we are going to talk about Prognostication in Advanced Diseases, Part II. So in
More informationBest of Pulmonary Jennifer R. Hucks, MD University of South Carolina School of Medicine
Best of Pulmonary 2012-2013 Jennifer R. Hucks, MD University of South Carolina School of Medicine Topics ARDS- Berlin Definition Prone Positioning For ARDS Lung Protective Ventilation In Patients Without
More informationCourse Handouts & Post Test
STROKE/COMA: DISEASE TRAJECTORY AND HOSPICE ELIGIBILITY Terri L. Maxwell PhD, APRN VP, Strategic Initiatives Weatherbee Resources Hospice Education Network Course Handouts & Post Test To download presentation
More informationWhat is the next best step?
Noninvasive Ventilation William Janssen, M.D. Assistant Professor of Medicine National Jewish Health University of Colorado Denver Health Sciences Center What is the next best step? 65 year old female
More informationUnderstanding Dying in America
Understanding Dying in America Kenneth Brummel-Smith, MD Charlotte Edwards Maguire Professor of Geriatrics Florida State University College of Medicine Topics Prognosis & severity How we die Advance care
More informationHow Can Palliative Care Help Your Patient Get Home Sooner?
How Can Palliative Care Help Your Patient Get Home Sooner? Annette T. Carron, D.O. Director Geriatrics and Palliative Care Botsford Hospital OMED 2014 Patient Care Issues That Can Delay Your Day/ Pain
More informationPrimary Diagnosis YES NO ICD - Code Cancer Cognitive impairment Cardiac Respiratory Neurological Musculoskeletal Respiratory Other
Chart review date: / / Reviewer: Centre Name: Hospital Home RACF DOB: / / AGE: GENDER: Male Female Admission Date: / / Death Date: / / 1. DIAGNOSIS Primary Diagnosis YES NO ICD - Code Cancer Cognitive
More informationNeuroprognostication after cardiac arrest
Neuroprognostication after cardiac arrest Sam Orde 1st May 2018 Set the scene 55 yo man, found collapsed in park, looks like he d been jogging, no pulse, bystander CPR, ambulance arrives 5 mins later,
More informationUCSF PAIN SUMMIT /8/15
UCSF PAIN SUMMIT 2015 5/8/15 Case 3 Geriatric Pain Disclosure Statements UCSF PAIN SUMMIT 2015 Wendy Anderson Patrice Villars 5/8/15 Case 3 Geriatric Pain Pain Management in the Geriatric & End-of-Life
More informationBeth Cetanyan, RN AHA RF Aka The GURU
* Beth Cetanyan, RN AHA RF Aka The GURU *Discuss common causes of Pediatric CA *Review current PALS Guidelines *Through case presentations and discussion, become more comfortable and confident in providing
More informationDECISION MAKING SUPPORT AT END OF LIFE: ADVANCED DEMENTIA QUALITY OF LIFE
DECISION MAKING SUPPORT AT END OF LIFE: ADVANCED DEMENTIA QUALITY OF LIFE Ana Tuya Fulton, MD, FACP Chief of Geriatrics, Care New England Health System Medical Director, Integra Community Care Network,
More informationMedication Safety Tips. Gerry Maloney, DO, CPPS Dept of Emergency Medicine CWRU/MetroHealth Medical Center
Medication Safety Tips Gerry Maloney, DO, CPPS Dept of Emergency Medicine CWRU/MetroHealth Medical Center None Disclosures Objectives Discuss the evolution of the patient safety movement and its implications
More informationECMO for Severe Hypoxemic Respiratory Failure: Pro-Con Debate. Carolyn Calfee, MD MAS Mark Eisner, MD MPH
ECMO for Severe Hypoxemic Respiratory Failure: Pro-Con Debate Carolyn Calfee, MD MAS Mark Eisner, MD MPH June 3, 2010 Case Presentation Setting: Community hospital, November 2009 29 year old woman with
More informationa. Will not suppress respiratory drive in acute asthma
Status Asthmaticus & COPD with Respiratory Failure - Key Points M.J. Betzner MD FRCPc - NYEMU Toronto 2018 Overview This talk is about the sickest of the sick patients presenting with severe or near death
More informationCritical Incidents Reported to Manitoba Health
Critical Incidents Reported to Manitoba Health July 1, 2012 - September 30, 2012 Degree of Patient had a history of vasculopathy & low hemoglobin. Restricted blood supply resulted in vision loss in one
More informationDyspnea. Stephanie Lindsay
Dyspnea Stephanie Lindsay What is dyspnea? An unpleasant sensation of difficult, labored breathing Shortness of air Dyspnea is not the same as tachypnea therefore patients may not present with rapid breathing
More informationRapid Response Teams and End-of-Life Care. James Downar, MDCM, MHSc, FRCPC Critical Care and Palliative Care, University Health Network, Toronto
Rapid Response Teams and End-of-Life Care James Downar, MDCM, MHSc, FRCPC Critical Care and Palliative Care, University Health Network, Toronto Conflicts of Interest To place your ad here, please call
More informationPALLIATIVE CARE GOALS of CARE: DNR. Debra Luczkiewicz MD Kelly Denall ANP Supportive Medical Partners
PALLIATIVE CARE GOALS of CARE: DNR Debra Luczkiewicz MD Kelly Denall ANP Supportive Medical Partners OBJECTIVES Understand the scope of palliative care. Describe the differences between Hospice and palliative
More informationA Practical Approach to Palliative Care in the ICU
A Practical Approach to Palliative Care in the ICU Wendy Anderson, MD MS Critical Care Medicine and Trauma May 31, 2013 Disclosure Statement Dr. Anderson has no relevant financial relationships to disclose.
More informationApproach to symptom control near the end-of-life
Approach to symptom control near the end-of-life 18 Sept 2011 Dr Alethea Yee Senior Consultant, Department of Palliative Medicine National Cancer Centre,Singapore What is end of life? No precise definition
More informationSedation and Delirium Questions
Sedation and Delirium Questions TLC Curriculum William J. Ehlenbach, MD MSc Assistant Professor of Medicine Pulmonary & Critical Care Medicine Question 1 Deep sedation in ventilated critically patients
More informationTransfusion Reactions
Transfusion Reactions From A to T Provincial Blood Coordinating Program Daphne Osborne MN PANC (C) RN We want you to know Definition Appropriate actions Classification Complete case studies Transfusion
More informationWhat You Need To Know About Palliative Care. Natalie Wu Moy, LCSW, MSPA RUHS Medical Center Hospital Social Services Director
What You Need To Know About Palliative Care Natalie Wu Moy, LCSW, MSPA RUHS Medical Center Hospital Social Services Director None of the faculty, planners, speakers, providers, nor CME committee members
More informationHIV & Mental Health. Shaun Watson, Clinical Nurse Specialist (HIV. Community) Westminster, London. UK
HIV & Mental Health Shaun Watson, Clinical Nurse Specialist (HIV Community) Westminster, London. UK HIV Depression & Anxiety ARV related issues Bipolar Disorders Personality Disorders Dementia HIV & Mental
More informationVentilator Withdrawal: Procedures and Outcomes. Report of a Collaboration Between a Critical Care Division and a Palliative Care Service
954 Journal of Pain and Symptom Management Vol. 26 No. 4 October 2003 Clinical Note Ventilator Withdrawal: Procedures and Outcomes. Report of a Collaboration Between a Critical Care Division and a Palliative
More informationAdvance Care Planning: What s the Physician s Role? Dr. Tim Jessick Palliative Medicine Aurora West Allis Medical Center October, 2015
Advance Care Planning: What s the Physician s Role? Dr. Tim Jessick Palliative Medicine Aurora West Allis Medical Center October, 2015 Objectives Define usual medical care vs palliative care vs hospice
More informationObjectives. Sometimes We Get Ahead of Ourselves 3/6/2015
Withholding and Withdrawing No Longer Beneficial Medical Interventions: Historical, Ethical and Practical Issues Marcia Levetown, MD FAAHPM HealthCare Communication Assocs Houston, TX mlevetown@earthlink.net
More informationTHE ROLE OF PALLIATIVE CARE IN TREATMENT OF PATIENTS WITH CHRONIC, INFECTIOUS DISEASE
THE ROLE OF PALLIATIVE CARE IN TREATMENT OF PATIENTS WITH CHRONIC, INFECTIOUS DISEASE JESSICA MCFARLIN MD ASSISTANT PROFESSOR OF NEUROLOGY DIVISION CHIEF, PALLIATIVE AND SUPPORTIVE CARE I HAVE NO COI OR
More informationEND-OF-LIFE DECISIONS HONORING THE WISHES OF A PERSON WITH ALZHEIMER S DISEASE
END-OF-LIFE DECISIONS HONORING THE WISHES OF A PERSON WITH ALZHEIMER S DISEASE PREPARING FOR THE END OF LIFE When a person with late-stage Alzheimer s a degenerative brain disease nears the end of life
More informationThe paper provides an update for the Trust Board on hospital mortality and presents the updated Trust Mortality Action Plan.
ENC No 13 Meeting Trust Board Date 28 th November 2013 Title of Paper Lead Director Author Hospital Mortality Update Mr Amir Khan, Medical Director Mr Amir Khan, Medical Director PURPOSE OF THE PAPER The
More informationCase: 65 year old post-cardiac arrest patient with myoclonus
Case: 65 year old post-cardiac arrest patient with myoclonus David B. Seder MD, FCCP, FCCM, FNCS Associate Professor of Medicine Tufts University School of Medicine Interim Department Chief and Director
More informationKeeping Patients Off the Vent: Bilevel, HFNC, Neither?
Keeping Patients Off the Vent: Bilevel, HFNC, Neither? Robert Kempainen, MD Pulmonary and Critical Care Medicine Hennepin County Medical Center University of Minnesota School of Medicine Objectives Summarize
More informationHospice May Prolong Life
OBJECTIVES Shatter some myths about Hospice care Revisit difference between Hospice/PC Learn to use a Discussion Guide to clarify GOC Expand the Letterman Technique of Presentation Myths Myth # 20, Prognostic
More informationPrimary Palliative Care
Primary Palliative Care Amanda Overstreet, DO October 20, 2017 No financial disclosures Objectives Discuss palliative care and how it differs from hospice Explore how to manage patients goals and expectations
More informationNo conflicts of interest
Robert M. Rodriguez, MD FAAEM Clinical Professor of Medicine and Emergency Medicine, UCSF No conflicts of interest Major Points Most ICU patients start in ED Chain of critical care starting in field and
More informationPalliative Pearls for the Cardiac Patient
Palliative Pearls for the Cardiac Patient 1 Lisa Simonian, DNP, CRNP, SANE-A Geoffrey P. Dunn, MD, FACS Liz Stroup, MSW Objectives Revisit the definition and purpose of Palliative Care Discuss palliative
More informationCancer and Advance Care Planning You ve been diagnosed with cancer. Now what?
Cancer and Advance Care Planning You ve been diagnosed with cancer. Now what? ACP Cancer Booklet-- Patient_FINAL.indd 1 You have a lot to think about and it can be difficult to know where to start. One
More informationChapter 10: Diseases of the Respiratory System J 00-J99
Chapter 10: Diseases of the Respiratory J 00-J99 J00 J06 Acute upper respiratory infections J10 J18 Influenza and pneumonia J20 J22 Other acute lower respiratory infections J30 J39 Other diseases of upper
More informationI want to Die a Free man : The Psycho-Social-Spiritual Issues Surrounding Death in the Prison System
I want to Die a Free man : The Psycho-Social-Spiritual Issues Surrounding Death in the Prison System Loretta Lee Grumbles, MD Associate Professor of Medicine Director of Palliative Medicine Division Department
More informationRoad Blocks in Non-Cancer Palliative Care Obstacles observed from outpatient non-cancer palliative practice.
Road Blocks in Non-Cancer Palliative Care Obstacles observed from outpatient non-cancer palliative practice. 25th Annual Palliative Education and Research Days, West Edmonton Mall. Edmonton. 2014 Amanda
More informationThe Role of Clergy Through the Eyes of a Hospice and Palliative Care Physician. Laurie Hanne DO Aultman Hospice and Palliative Care
The Role of Clergy Through the Eyes of a Hospice and Palliative Care Physician Laurie Hanne DO Aultman Hospice and Palliative Care About Me My Training What led me to hospice and palliative care My new
More informationAchieving earlier entry to hospice care: Issues and strategies. Sonia Lee, APN, GCNS-BC
Achieving earlier entry to hospice care: Issues and strategies Sonia Lee, APN, GCNS-BC Objectives The learner will: Describe the benefits of hospice List at least barriers to early hospice care List at
More informationPALS Case Scenario Testing Checklist Respiratory Case Scenario 1 Upper Airway Obstruction
Respiratory Case Scenario 1 Upper Airway Obstruction Directs administration of 100% oxygen or supplementary oxygen as needed to support oxygenation Identifies signs and symptoms of upper airway obstruction
More informationHeart Failure Vital steps for palliative care. Dr Karen J Hogg Glasgow Royal Infirmary
Heart Failure Vital steps for palliative care Dr Karen J Hogg Glasgow Royal Infirmary Overview Why is heart failure a problem? Why do we need integrated cardiology and palliative care services? Cardiology
More information